Predicting ß-lactam resistance using whole genome sequencing in Klebsiella pneumoniae: the challenge of ß-lactamase inhibitors.
Diagn Microbiol Infect Dis
; 98(3): 115149, 2020 Nov.
Article
em En
| MEDLINE
| ID: mdl-32858260
ABSTRACT
Although multiple antimicrobial resistance (AMR) determinants can confer the same in vitro antimicrobial susceptibility testing (AST) phenotype, their differing effect on optimal therapeutic choices is uncertain. Using a large population-based collection of clinical strains spanning a 3.5-year period, we applied WGS to detect inhibitor resistant (IR), extended-spectrum ß-lactamase (ESBL), and carbapenem resistant (CR) ß-lactamase (bla) genes and compared the genotype to the AST phenotype in select isolates. All blaNDM-1 (9/9) and the majority of blaNDM-1/OXA-48 (3/4) containing isolates were resistant to CAZ/AVI as predicted by WGS. The combination of ATM and CAZ/AVI restored susceptibility by disk diffusion assay. Unexpectedly, clinical Kp isolates bearing blaKPC-8 (V240G) and blaKPC-14 (G242 and T243 deletion) did not test fully resistant to CAZ/AVI. Lastly, despite the complexity of the ß-lactamase background, CAZ/AVI retained potency. Presumed phenotypes conferred by AMR determinants need to be tested if therapeutic decisions are being guided by their presence or absence.
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MEDLINE
Assunto principal:
Beta-Lactamas
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Inibidores de beta-Lactamases
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Klebsiella pneumoniae
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Antibacterianos
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article